161 NE 92 St (2)Date I I - Job Address I C o I N t a S Tax Folio 11- S a o iv - o 3- 3 e
M i ' i
Legal Description /,. c. 4 �` 3 / L3 11 3 �-esSPc I Historically Designated: Yes No
Owner/Lessee / Tenant r` ) .S a r- P e S e K Master Permit # 4 e
Owner's Address N E Phone - 7 S 7 - Co 9 S `l
Contracting Co. (AJ e._ r
Qualifier Ma r 4 R. 1.4-n ct e - s o ✓1
State # E POO L &) Co J Municipal #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILD
WORK DESCRIPTION
Square Ft. Estimated Cost (value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOU r' FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR ROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/or Condc/President
n.st r - R s �K
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date
1/
Notary as to Owner and/or Condo President Dat
MyC0 nissio K. TUCKER
rm rn COMMISSION # CC 631227
v� �� c EXPIRES MAY 5, 2001
BONDED THRU
OF P ATLANTIC BONDING CO., INC.
FEES: PERMIT ;"`1d' RADON
ING MECHANICAL ROOFING PAVING IFENCE SIGN
Competency # Ins. Co.
Address
Address
Address
SS# - / Phone ( 3 - 70 O 36
Address
3 7 ca-4- 7,}P
fl2
Sjgna or Owner- Builder
C.C.F. NOTARY
r TUCKK r E - R Builder
4 CC 631227
CQ EXPIRES MAY 5, 2001
BONDED THRU
OF Fe ATLANTIC BONDING CO., INC.
BOND
TOTAL DUE
APPROVED:
Zoning Building Electrical ��
Mechanical Plumbing Engineering
J
Date
Ill��
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